Validación de un nuevo modelo de simulación inorgánica para la anastomosis uretrovesical laparoscópica / Validation of a new artificial model for simulated training of a laparoscopic vesicourethral anastomosis

Objetivo: El objetivo de este estudio es demostrar la validez de un modelo inorgánico de bajo coste para el aprendizaje y entrenamiento de la anastomosis uretrovesical laparoscópica. Materiales y métodos: En este estudio participaron alumnos que asistieron a alguna de las ediciones de los cursos monográficos sobre prostatectomía radical laparoscópica (PRL) celebrados durante el periodo de 2015 a 2017. Estos participantes se dividieron en 2 grupos de acuerdo con su experiencia previa en cirugía laparoscópica (CL). Las tareas que realizaron sobre el simulador inorgánico fueron la resección de la próstata, "tarea 1" y la anastomosis uretrovesical, "tarea 2". Una vez realizados estos ejercicios, los participantes del estudio completaron un cuestionario anónimo donde se recogieron sus datos demográficos y su nivel de experiencia en CL. Además, los asistentes realizaron una valoración de la capacidad didáctica del órgano sintético empleado, evaluando su utilidad como herramienta para la formación específica de PRL. Para demostrar la validación aparente y de contenidos los participantes mostraron su opinión acerca de la textura, la consistencia, la morfología y la similitud del órgano con el paciente real. La valoración se realizó según una escala de Likert de 5 puntos. Resultados: Los alumnos se distribuyeron en 2 grupos: 10 expertos (grupo E) y 12 noveles (grupo N). La única diferencia significativa entre las puntuación de noveles y de expertos fue respecto a la inclusión de esta herramienta en los programas de formación (grupo E = 5 puntos frente al grupo N = 4,4 ± 0,59, p = 0,024). Los expertos calificaron todas las cuestiones con mayores puntaciones que los noveles. En cuanto a la valoración general del modelo inorgánico, los participantes noveles dieron una calificación media de 8,00±0,91 puntos sobre 10, siendo superada por la valoración de los participantes del grupo de expertos, que dieron una puntuación media de 9,4 ± 0,51. Conclusión: Este modelo inorgánico ha demostrado poseer validez aparente, de contenidos y constructiva, además de ser una herramienta didáctica ideal para el aprendizaje y el entrenamiento de la resección prostática y de la anastomosis uretrovesical laparoscópica

Objective: The aim of this study is to prove the effectiveness of a low cost, artificial model for training of a laparoscopic urethrovesical anastomosis. Materials and methods: This study included urologists who attended specialised courses on laparoscopic radical prostatectomy (LRP) held during the period 2015 to 2017. They were divided into 2 groups according to their previous experience in laparoscopic surgery. The tasks performed on the artificial simulator were prostate resection, "task 1", and urethrovesical anastomosis, "task 2". Once these exercises were completed, the study participants filled in an anonymous questionnaire regarding their demographic data and experience level in laparoscopic surgery (LS). In addition, they gave their opinions about the didactic capacity of the artificial organ and evaluated its usefulness as a tool for LRP training. To demonstrate face and content validity, the participants judged the texture, consistency, morphology and evaluated its similarity to the real organ. The assessment was made with a five-point Likert scale. Results: The students were divided into 2 groups: 10 experts (Group E) and 12 novices (Group N). The only significant difference between the scores of novices and experts was regarding the inclusion of this tool in the training programs (Group E = 5 points versus group N = 4.4 ± 0.59, P = .024). The experts' group rated all the items with higher scores than the novices’ one. Regarding the general assessment of the simulation model, the novice participants gave an average score of 8.00 ± 0.91 points out of 10, while the experts’ group granted higher scores of 9.4 ± 0,51. Conclusion: This artificial model has shown to have an elevated face, content and construct validity, as well being an optimal didactic tool for training in the techniques of prostate resection and laparoscopic urethrovesical anastomosis

Validation of a new artificial model for simulated training of a laparoscopic vesicourethral anastomosis. / Validación de un nuevo modelo de simulación inorgánica para la anastomosis uretrovesical laparoscópica.

OBJECTIVE: The aim of this study is to prove the effectiveness of a low cost, artificial model for training of a laparoscopic urethrovesical anastomosis. MATERIALS AND METHODS: This study included urologists who attended specialised courses on laparoscopic radical prostatectomy (LRP) held during the period 2015 to 2017. They were divided into 2 groups according to their previous experience in laparoscopic surgery. The tasks performed on the artificial simulator were prostate resection, "task 1", and urethrovesical anastomosis, "task 2". Once these exercises were completed, the study participants filled in an anonymous questionnaire regarding their demographic data and experience level in laparoscopic surgery (LS). In addition, they gave their opinions about the didactic capacity of the artificial organ and evaluated its usefulness as a tool for LRP training. To demonstrate face and content validity, the participants judged the texture, consistency, morphology and evaluated its similarity to the real organ. The assessment was made with a five-point Likert scale. RESULTS: The students were divided into 2groups: 10 experts (Group E) and 12 novices (Group N). The only significant difference between the scores of novices and experts was regarding the inclusion of this tool in the training programs (Group E=5 points versus group N=4.4±0.59, P=.024). The experts' group rated all the items with higher scores than the novices' one. Regarding the general assessment of the simulation model, the novice participants gave an average score of 8.00±0.91 points out of 10, while the experts' group granted higher scores of 9.4±0,51. CONCLUSION: This artificial model has shown to have an elevated face, content and construct validity, as well being an optimal didactic tool for training in the techniques of prostate resection and laparoscopic urethrovesical anastomosis.

Úlceras por presión en pacientes ingresados en Medicina Interna: factores asociados y mortalidad / Pressure ulcers in patients hospitalized in Internal Medicine: associated factors and mortality

Objetivo. Determinar la prevalencia de las úlceras por presión en pacientes hospitalizados en Medicina Interna y los factores clínicos y riesgo de muerte asociados a su presencia. Pacientes y métodos. Estudio prospectivo de cohortes con pacientes ingresados en Medicina Interna. Se recogieron la edad, sexo, presencia de úlceras por presión, grado de la úlcera, índice de Barthel, escala de Norton, categoría diagnóstica mayor, duración de la estancia hospitalaria y peso del grupo relacionado de diagnóstico. Se compararon las características clínicas de los pacientes con o sin úlceras y se analizó la mortalidad al cabo de 3 años en función de la presencia de úlceras. Resultados. Se incluyeron 699 pacientes, de los que 100 (14,3%) presentaron úlceras por presión (27 de grado I, 17 de grado II, 21 de grado III, 25 de grado IV y 10 de grado no conocido). El índice de Barthel (OR 0,985 IC95% 0,972-0,998; p=0,022) y la escala de Norton (OR 0,873 IC95% 0,780-0,997; p=0,018) se asociaron de forma independiente con las úlceras. Durante el ingreso fallecieron el 23% de los pacientes con úlceras, al cabo de un año el 68% y a los 3 años el 83%. La presencia de úlceras por presión se asoció de forma independiente con la mortalidad (HR 1,531, IC95% 1,140-2,056, p=0,005). Conclusiones. Las úlceras por presión son frecuentes en los pacientes hospitalizados en Medicina Interna y su presencia se asocia con mayor mortalidad a corto, medio y largo plazo (AU)

Objective. To determine the prevalence of pressure ulcers in patients hospitalized in internal medicine and the clinical factors and risk of death associated with its presence. Patients and methods. Prospective cohort study with patients hospitalized in internal medicine. We recorded the age, sex, presence of pressure ulcers, degree of ulceration, Barthel index, Norton scale, major diagnostic category, length of hospital stay and weight of the diagnosis-related groups. We compared the clinical characteristics of the patients with or without ulcers and analysed the mortality after 3 years based on the presence of ulcers. Results. The study included 699 patients, 100 of whom (14.3%) had pressure ulcers (27 with grade I, 17 with grade II, 21 with grade III, 25 with grade IV and 10 with unknown grade). The Barthel index (OR 0.985; 95% CI 0.972-0.998; p=.022) and Norton scale (OR 0.873; 95% CI 0.780-0.997; p=.018) are independently associated with ulcers. Twenty-three percent of the patients with ulcers died during hospitalization, 68% died within a year, and 83% died within 3 years. The presence of pressure ulcers was independently associated with mortality (HR, 1.531; 95% CI 1.140-2.056; p=.005). Conclusions. Pressure ulcers are common in patients hospitalized in internal medicine, and their presence is associated with higher short, medium and long-term mortality (AU)

Pressure ulcers in patients hospitalized in Internal Medicine: associated factors and mortality. / Úlceras por presión en pacientes ingresados en Medicina Interna: factores asociados y mortalidad.

OBJECTIVE: To determine the prevalence of pressure ulcers in patients hospitalized in internal medicine and the clinical factors and risk of death associated with its presence. PATIENTS AND METHODS: Prospective cohort study with patients hospitalized in internal medicine. We recorded the age, sex, presence of pressure ulcers, degree of ulceration, Barthel index, Norton scale, major diagnostic category, length of hospital stay and weight of the diagnosis-related groups. We compared the clinical characteristics of the patients with or without ulcers and analysed the mortality after 3 years based on the presence of ulcers. RESULTS: The study included 699 patients, 100 of whom (14.3%) had pressure ulcers (27 with grade I, 17 with grade II, 21 with grade III, 25 with grade IV and 10 with unknown grade). The Barthel index (OR 0.985; 95% CI 0.972-0.998; p=.022) and Norton scale (OR 0.873; 95% CI 0.780-0.997; p=.018) are independently associated with ulcers. Twenty-three percent of the patients with ulcers died during hospitalization, 68% died within a year, and 83% died within 3 years. The presence of pressure ulcers was independently associated with mortality (HR, 1.531; 95% CI 1.140-2.056; p=.005). CONCLUSIONS: Pressure ulcers are common in patients hospitalized in internal medicine, and their presence is associated with higher short, medium and long-term mortality.

Validación inicial de un programa de formación enfocado a la nefrectomía radical laparoscópica / Initial validation of a training program focused on laparoscopic radical nephrectomy

Objetivo: Evaluar un modelo de formación enfocado a la nefrectomía laparoscópica. Material y métodos: Participaron en el estudio 16 residentes, quienes realizaron un programa formativo con una sesión teórica (1 h) y práctica en simulador (7 h) y modelo animal (13 h). La primera y última nefrectomía experimental fue evaluada mediante el tiempo y la escala global Objective and Structured Assessment of Technical Skills(OSATS). Antes y después del curso realizaron 3 ejercicios en el simulador de realidad virtual LAPMentor: 1) coordinación ojo-mano; 2) coordinación mano-mano; y 3) transferencia de objetos, registrando las métricas de tiempo y movimiento. Todos los participantes rellenaron un cuestionario sobre los componentes formativos en una escala del 1 al 5. Resultados: Los participantes realizaron la última nefrectomía más rápido (p < 0,001) y con mayor puntuación OSATS (p < 0,001). Después del curso realizaron los ejercicios en LAPMentor más rápido (p < 0,05). El número de movimientos disminuyó en todos los ejercicios: 1) p < 0,001; 2) p < 0,05; y 3) p < 0,05, y la distancia recorrida en los ejercicios 1 (p < 0,05) y 2 (p < 0,05). La velocidad de movimientos aumentó en los ejercicios 2 (p < 0,001) y 3 (p < 0,001). En el cuestionario las preguntas con la mayor puntuación fueron la utilidad del entrenamiento en animal y la necesidad del mismo antes de la práctica de laparoscopia clínica (4,92 ± 0,28). Conclusiones: La combinación de simulación física y entrenamiento en animal constituye un modelo de formación efectivo para la mejora de habilidades básicas y avanzadas para la nefrectomía laparoscópica. El componente preferido por los residentes fue el modelo animal

Objective: To assess a training model focused on laparoscopic nephrectomy. Material and methods: 16 residents participated in the study, who attended a training program with a theoretical session (1 hour) and a dry (7 hours) and a wet lab (13 hours). During animal training, the first and last nephrectomies were assessed through the completion time and the global rating scale "Objective and Structured Assessment of Technical Skills" (OSATS). Before and after the course, they performed 3 tasks on the virtual reality simulator LAPMentor (1) eye-hand coordination; 2) hand-hand coordination; and 3) transference of objects), registering time and movement metrics. All participants completed a questionnaire related to the training components on a 5-point rating scale. Results: The participants performed the last nephrectomy faster (P < .001) and with higher OSATS scores (P < .001). After the course, they completed the LAPMentor tasks faster (P < .05). The number of movements decreased in all tasks (1) P < .001, 2) P < .05, and 3) P < .05), and the path length in tasks 1 (P < .05) and 2 (P < .05). The movement speeds increased in tasks 2 (P < .001) and 3 (P < .001). With regards to the questionnaire, the usefulness of the animal training and the necessity of training on them prior to their laparoscopic clinical practice were the questions with the highest score (4.92 ± .28). Conclusions: The combination of physical simulation and animal training constitute an effective training model for improving basic and advanced skills for laparoscopic nephrectomy. The component preferred by the urology residents was the animal training

Initial validation of a training program focused on laparoscopic radical nephrectomy. / Validación inicial de un programa de formación enfocado a la nefrectomía radical laparoscópica.

OBJECTIVE: To assess a training model focused on laparoscopic nephrectomy. MATERIAL AND METHODS: 16 residents participated in the study, who attended a training program with a theoretical session (1hour) and a dry (7hours) and a wet lab (13hours). During animal training, the first and last nephrectomies were assessed through the completion time and the global rating scale "Objective and Structured Assessment of Technical Skills" (OSATS). Before and after the course, they performed 3 tasks on the virtual reality simulator LAPMentor (1) eye-hand coordination; 2) hand-hand coordination; and 3) transference of objects), registering time and movement metrics. All participants completed a questionnaire related to the training components on a 5-point rating scale. RESULTS: The participants performed the last nephrectomy faster (P<.001) and with higher OSATS scores (P<.001). After the course, they completed the LAPMentor tasks faster (P<.05). The number of movements decreased in all tasks (1) P<.001, 2) P<.05, and 3) P<.05), and the path length in tasks 1 (P<.05) and 2 (P<.05). The movement speeds increased in tasks 2 (P<.001) and 3 (P<.001). With regards to the questionnaire, the usefulness of the animal training and the necessity of training on them prior to their laparoscopic clinical practice were the questions with the highest score (4.92±.28). CONCLUSIONS: The combination of physical simulation and animal training constitute an effective training model for improving basic and advanced skills for laparoscopic nephrectomy. The component preferred by the urology residents was the animal training.

Diseño y validación de un simulador para el entrenamiento en la capsulotomía circular continua en la facoemulsificación / Design and validation of a simulator for training in continuous circular capsulotomy for phacoemulsification

Introducción: Diseñar y validar un simulador para el aprendizaje y entrenamiento de la técnica de la capsulorrexis. Métodos: El sistema consiste en un soporte de metacrilato con inclinación de 15° para el apoyo de las manos del cirujano y una zona de papel aluminio comercial y otro de similares características donde el alumno realiza la técnica a través de unas hendiduras realizadas previamente en el soporte. Para evaluar la viabilidad de este simulador se toman los datos de 65 oftalmólogos que realizan la técnica durante actividades de formación, dividiéndolos aleatoriamente en un grupo de 30 especialistas que inician directamente su aprendizaje en ojos de cadáver de animal y en otro grupo de 35 especialistas que se inician previamente con este simulador. Resultados: Se desarrolla un simulador para entrenamiento de la técnica de capsulorrexis. El grupo de alumnos del grupo simulador consigue una reducción en el uso de ojos de cadáver y una mayor eficiencia en la realización de capsulorrexis correctas, a diferencia del grupo que se inicia directamente en ojos de cadáver. Conclusiones: Este simulador constituye una novedad en el entrenamiento de la técnica de capsulorrexis en cuanto a sencillez, coste y reutilización, frente a otros simuladores virtuales con equipos informáticos más costosos y más complicados de transportar. Es pieza clave como paso previo a la utilización de piezas de cadáver y de animales de experimentación, disminuyendo el número de ambos y, por tanto, el coste de la enseñanza (AU)

Introduction: To design and validate a simulator for learning and training in the capsulorhexis technique. Methods: The system consists of a methacrylate support inclined 15° for the surgeon's hand, an area of commercially available aluminum foil, and another one of similar characteristics, where the student performs the technique through some slots that are previously made in the support. In order to evaluate the feasibility of this simulator, data were collected from 65 ophthalmologists performing the technique during training activities. The ophthalmologists were randomly divided into one group of 30 specialists who start their learning on the eyes of an animal cadaver, and into another of 35 specialists who previously started with this simulator. Results: A simulator is developed for training in the capsulorhexis technique. The students from the simulator group achieved a reduction in the use of cadaver eyes, and a higher efficiency in correct capsulorhexis, unlike the group who started directly on the cadaver eyes. Conclusions: This simulator is an innovation in training of the capsulorhexis technique as regards simplicity, cost, and reuse, as compared to other virtual simulators with more expensive computer equipment (CE) equipment that are more difficult to transport. It is an important step prior to the use of cadaver parts and experimental animals, decreasing the number of both, and therefore the teaching costs (AU)

[Design and validation of a simulator for training in continuous circular capsulotomy for phacoemulsification]. / Diseño y validación de un simulador para el entrenamiento en la capsulotomía circular continua en la facoemulsificación.

INTRODUCTION: To design and validate a simulator for learning and training in the capsulorhexis technique. METHODS: The system consists of a methacrylate support inclined 15° for the surgeon's hand, an area of commercially available aluminum foil, and another one of similar characteristics, where the student performs the technique through some slots that are previously made in the support. In order to evaluate the feasibility of this simulator, data were collected from 65 ophthalmologists performing the technique during training activities. The ophthalmologists were randomly divided into one group of 30 specialists who start their learning on the eyes of an animal cadaver, and into another of 35 specialists who previously started with this simulator. RESULTS: A simulator is developed for training in the capsulorhexis technique. The students from the simulator group achieved a reduction in the use of cadaver eyes, and a higher efficiency in correct capsulorhexis, unlike the group who started directly on the cadaver eyes. CONCLUSIONS: This simulator is an innovation in training of the capsulorhexis technique as regards simplicity, cost, and reuse, as compared to other virtual simulators with more expensive computer equipment (CE) equipment that are more difficult to transport. It is an important step prior to the use of cadaver parts and experimental animals, decreasing the number of both, and therefore the teaching costs.

EFSUMB minimum training requirements for rheumatologists performing musculoskeletal ultrasound.

In order to optimize and standardize musculoskeletal ultrasonography education for rheumatologists, there is a need for competency assessments addressing the required training and practical and theoretical skills. This paper describes how these competency assessments for rheumatologists were developed and what they contain.

Response to methylphenidate by adult and pediatric patients with attention-deficit/hyperactivity disorder: the Spanish multicenter DIHANA study.

BACKGROUND: The purpose of this multicenter Spanish study was to evaluate the response to immediate-release methylphenidate by children and adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), as well as to obtain information on current therapy patterns and safety characteristics. METHODS: This multicenter, observational, retrospective, noninterventional study included 730 patients aged 4-65 years with a diagnosis of ADHD. Information was obtained based on a review of medical records for the years 2002-2006 in sequential order. RESULTS: The ADHD predominantly inattentive subtype affected 29.7% of patients, ADHD predominantly hyperactive-impulsive was found in 5.2%, and the combined subtype in 65.1%. Overall, a significant lower Clinical Global Impression (CGI) score and mean number of DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision) symptoms by subtype were found after one year of treatment with immediate-release methylphenidate; CGI decreased from 4.51 to 1.69, symptoms of inattention from 7.90 to 4.34, symptoms of hyperactivity from 6.73 to 3.39, and combined subtype symptoms from 14.62 to 7.7. Satisfaction with immediate-release methylphenidate after one year was evaluated as "very satisfied" or "satisfied" by 86.90% of the sample; 25.75% of all patients reported at least one adverse effect. At the end of the study, 41.47% of all the patients treated with immediate-release methylphenidate were still receiving it, with a mean time of 3.80 years on therapy. CONCLUSION: Good efficacy and safety results were found for immediate-release methylphenidate in patients with ADHD.

Electronic device for endosurgical skills training (EDEST): study of reliability.

PURPOSE: Minimally Invasive Surgery procedures are commonly used in many surgical practices, but surgeons need specific training models and devices due to its difficulty and complexity. In this paper, an innovative electronic device for endosurgical skills training (EDEST) is presented. A study on reliability for this device was performed. METHOD: Different electronic components were used to compose this new training device. The EDEST was focused on two basic laparoscopic tasks: triangulation and coordination manoeuvres. A configuration and statistical software was developed to complement the functionality of the device. A calibration method was used to assure the proper work of the device. A total of 35 subjects (8 experts and 27 novices) were used to check the reliability of the system using the MTBF analysis. RESULTS: Configuration values for triangulation and coordination exercises were calculated as 0.5 s limit threshold and 800-11,000 lux range of light intensity, respectively. Zero errors in 1,050 executions (0%) for triangulation and 21 errors in 5,670 executions (0.37%) for coordination were obtained. A MTBF of 2.97 h was obtained. CONCLUSIONS: The results show that the reliability of the EDEST device is acceptable when used under previously defined light conditions. These results along with previous work could demonstrate that the EDEST device can help surgeons during first training stages.

Three-dimensional volumetric ultrasonography. Does it improve reliabililty of musculoskeletal ultrasound?

OBJECTIVE: To compare the interobserver reliability of three-dimensional (3D) volumetric ultrasonography (US) and 2D real-time US in detecting inflammatory and destructive changes in rheumatoid arthritis (RA) wrist and hand. METHODS: Two RA patients were selected by a rheumatologist who performed independently a grey-scale and power Doppler (PD) volumetric acquisition at three anatomic sites in their more symptomatic wrist/hand using two identical scanners equipped with 3D volumetric probe. Twelve rheumatologists expert in MSUS were randomly assigned to a US scanner and a patient. In the first part of the study, each group of experts blindly, independently, and consecutively performed a 2D real-time grey-scale and PD US investigation of inflammatory changes and/or bone erosions at the three anatomic sites. In the second part of the study, each group of investigators blindly evaluated the same pathologic changes in the 6 volumes from the patient not scanned by them. RESULTS: The kappa values were higher for 3D volumetric US than for 2D US in the detection of synovitis/tenosyno-vitis (0.41 vs. 0.37) and PD signal (0.82 vs 0.45) and in the PD signal grading (0.81 vs. 0.55). CONCLUSION: 3D volumetric US may improve the interobserver reliability in RA multicentre studies.

Morfometría del esófago abdominal y del estómago del conejo (Orycotolagus cuniculus): aplicaciones a la cirugía laparoscópica / Morphometry of the abdominal esophagus and stomach of the rabbit: laparoscopyc surgery applications

Actualmente existen pocos estudios sobre la anatomía y fisiología del tracto digestivo del conejo (Orycotolagus cuniculus), estos estudios están encaminados a la nutrición y biología del conejo, pero pocos abordan la anatomía con la visión de un cirujano. Por otro lado existen algunos estudios que proponen al conejo como modelo animal para cirugías laparoscópicas del esófago distal y el estómago. En la mayoría de los casos se utiliza como modelo sin tener en cuenta las características anatómicas específicas de esta especie, por lo que es fundamental realizar un estudio anatómico de la zona del esófago abdominal, cardias y estómago del conejo, que exprese las características y diferencias anatómicas para que los cirujanos estén más familiarizados antes de realizar prácticas laparoscópicas en esta especie. Una diferencia importante es la presencia de una porción grande de esófago abdominal. Está descrito que animales con porciones grandes de esófago abdominal, no tienen la posibilidad de regurgitar o vomitar. Esta diferencia anatómica es muy importante cuando se pretende usar a estos animales como modelo para la enfermedad por reflujo gastroesofágico (ERG).El presente trabajo se realiza con los objetivos de proporcionar a los cirujanos un estudio anatómico que permita conocer la zona del esófago abdominal, cardias y estómago del conejo, para que tengan conocimiento de las características propias en esta especie y las diferencias con el humano, en su uso como modelo animal para la cirugía del cardias y el estómago. Se realizaron medidas anatómicas al esófago y estómago de 18 conejos Nueva Zelanda Blancos de 2.5 a 3.5 Kg de peso de ambos sexos. Donde encontramos que el conejo presenta un una porción grande de esófago abdominal así como un estómago grande con una gran proporción de fundus gástrico.

Actuality, there are few studies about rabbits (Orycotolagus cuniculus) digestive tract anatomy and physiology. These studies are designed at nutrition and biology of the rabbit. But few deal with the anatomy of a surgeon's vision.There are also some researches that propose rabbits as laparoscopic surgery animal model for of the distal oesophagus and stomach. In most cases is used as a model without considering the specific anatomical characteristics of this species. So it is essential to make an anatomical study of the abdominal oesophagus, cardia, and stomach of the rabbit. This should express the characteristics and anatomical differences between species. On the way to that surgeon are more familiar before performing laparoscopic practices in this species. An important difference is the presence of a large portion of abdominal oesophagus. There is reported that animals with large portions of abdominal oesophagus, can not vomit or regurgitate. This anatomical difference is very important when trying to use these animals as a model for gastroesophageal reflux disease. This work is done with the objectives of providing surgeons an anatomical study of the abdominal esophagus, cardia and stomach of the rabbit, to have knowledge of the characteristics in this species and the differences with humans, when used as surgical animal model. Anatomical measures were made to the oesophagus and stomach of 18 males and females New Zealand White rabbits. Between 2,5 to 3,5 Kg. We find that the rabbit has a large portion of an abdominal oesophagus and a large stomach with a large proportion of gastric fundus.

Ultrasonographic monitoring of response to therapy in polymyalgia rheumatica.

OBJECTIVE: To assess the responsiveness of ultrasound (US) inflammatory findings in the shoulder and hip of patients with polymyalgia rheumatica (PMR) who started treatment with corticosteroids. METHODS: Fifty-three patients with active PMR who started treatment with prednisone in six Spanish centres were prospectively studied. The patients underwent clinical, laboratory and US assessment at baseline, 4 and 12 weeks. The US investigation consisted of detection and quantification of inflammatory findings in the shoulder and hip. The responsiveness of clinical, laboratory and US parameters was tested by the standardised response mean. Intraobserver and interobserver reliability between US investigators was assessed. RESULTS: At baseline, 34 patients (69%) had inflammation in at least one bilateral site. During the follow-up period, clinical, laboratory and US variables showed a parallel decrease. A significant decrease in US inflammatory parameters was found at week 4 (p<0.001). After 4 and 12 weeks of treatment with corticosteroids, US inflammatory findings showed similar or better sensitivity to change than clinical and laboratory markers of PMR activity. Intraobserver and interobserver intraclass correlation coefficients were 0.96 and 0.99, respectively (p<0.05). CONCLUSION: US may be a responsive additional tool in monitoring the response to corticosteroids in patients with PMR in daily practice and multicentre trials.

Ultrasound validity in the measurement of knee cartilage thickness.

OBJECTIVE: To assess the multiexaminer reproducibility and the accuracy comparing with cadaver anatomic specimens of ultrasound (US) measurement of femoral articular cartilage (FAC) thickness. METHODS: In 8 flexed cadaver knees, FAC thickness was blindly, independently and consecutively measured twice by 10 rheumatologists at the lateral condyle (LC), medial condyle (MC) and intercondylar notch (IN) with US. After the US measurements, the knees were dissected. Articular cartilage integrity was evaluated macroscopically in the femoral condyles. FAC thickness was blindly measured in the specimens using a stereoscopic magnifying loupe and a digitised image software. Interexaminer and intraexaminer reliability of US FAC thickness measurement and agreement between US and anatomic measurements were assessed by estimating the intraclass correlation coefficient (ICC). RESULTS: Interexaminer ICCs were higher than 0.90 for MC (p<0.001) and IN (p<0.001) and higher than 0.75 for LC (p<0.01). Mean intraexaminer ICCs were 0.832 for MC (p<0.001), 0.696 for LC (p<0.001) and, 0.701 for IN (p<0.001). Agreement between US and anatomic FAC thickness measurements was good for MC (ICC 0.719; p = 0.020) and poor for LC (p = 0.285) and IN (p = 0.332). Bland-Altman analysis showed that the difference between US and anatomic values was considerably high in the one knee with severely damaged FAC. After eliminating this knee from the analysis, ICCs were 0.883 (p<0.001) for MC, 0.795 (p = 0.016) for LC and 0.732 for IN (p = 0.071). CONCLUSION: US demonstrated a good reproducibility in FAC thickness measurement by multiple examiners. In addition, US FAC thickness measurement was accurate in normal to moderately damaged cartilage.

Validity of enthesis ultrasound assessment in spondyloarthropathy.

OBJECTIVES: To develop an ultrasound enthesis score and to assess its validity in the diagnostic classification of the spondyloarthropathies (SpAs). METHODS: Twenty-five patients with SpA and 29 healthy controls participated in a blinded, gender-matched, cross-sectional study involving ultrasound assessment. The following entheses were explored bilaterally: proximal plantar fascia, distal Achilles tendon, distal and proximal patellar ligament, distal quadriceps and brachial triceps tendons. The ultrasound score evaluated enthesis thickness, structure, calcifications, erosions, bursae and power Doppler signal. The value of each elemental lesion was calculated using a three-model analysis. Validity was analysed by receiver operating characteristic (ROC) curves. Inter-reader and interexplorer intraclass correlation coefficients (ICCs) were calculated. RESULTS: The logistic regression model overestimated the score of three elemental lesions: calcification (0-3), Doppler (0 or 3) and erosion (0 or 3), while scoring tendon structure, tendon thickness and bursa as 0 or 1. ROC curves established an ultrasound score of >or=18 as the best cut-off point for differentiation between cases and controls. This cut-off point was exceeded by 5/29 controls (17%) and by 21/25 patients with SpA (84%). The sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-) were 83.3%, 82.8%, 4.8% and 0.2%, respectively. The inter-reader and interexplorer ICCs were 0.60 and 0.86, respectively. CONCLUSION: The findings suggest that the ultrasound enthesis score could be a valid tool in the diagnosis of SpA.

Recommendations for the content and conduct of European League Against Rheumatism (EULAR) musculoskeletal ultrasound courses.

OBJECTIVE: To develop education guidelines for the conduct of future European League Against Rheumatism (EULAR) musculoskeletal ultrasound (MSUS) courses. METHODS: We undertook a consensus-based, iterative process using two consecutive questionnaires sent to 29 senior ultrasonographer rheumatologists who comprised the faculty of the 14th EULAR ultrasound course (June 2007). The first questionnaire encompassed the following issues: type of MSUS educational model; course timing; course curriculum; course duration; number of participants per teacher in practical sessions; time spent on hands-on sessions; and the requirements and/or restrictions for attendance at the courses. The second questionnaire consisted of questions related to areas where consensus had not been achieved in the first questionnaire, and to the topics and pathologies to be assigned to different educational levels. RESULTS: The response rate was 82.7% from the first questionnaire and 87.5% from the second questionnaire. The respondents were from 11 European countries. The group consensus on guidelines and curriculum was for a three-level education model (basic, intermediate and advanced) with timing and location related to the annual EULAR Congresses. The topics and pathologies to be included in each course were agreed. The course duration will be 20 h. There will be a maximum of six participants per teacher and 50-60% of total time will be spent on practical sessions. There was also agreement on prerequisite experience before attending the intermediate and advanced courses. CONCLUSION: We have developed European agreed guidelines for the content and conduct of EULAR ultrasound courses, which may also be recommended to national and local MSUS training programmes.

Technical feasibility of laparoscopic Finney pyloroplasty examined in a canine model.

The efficacy of laparoscopic surgery in the treatment of chronic duodenal ulcer has been demonstrated using minimally invasive approaches. This study aimed to evaluate the technical feasibility of laparoscopic Finney pyloroplasty in six dogs. Under laparoscopic guidance, the anastomosis was created using mechanical devices (n = 3) and combining a linear stapler device and intracorporeal suturing (n = 3). The operative time and complications were recorded. Evaluation of the anastomosis included studies of intraoperative and postoperative endoscopy and ultrasonography as well as the complete gastric emptying time. The animals were killed 4 weeks after surgery. Measurement of luminal diameter, amount of adhesion formation, degree of healing, and inflammation or fibrosis were evaluated in the postmortem studies. The operation was successfully completed for all the animals. No intraoperative or postoperative complications were observed. Gastric emptying was significantly enhanced in the postoperative period, as compared with the preoperative results. After 1 month, there was no evidence of anastomotic leak dehiscence at the gastroduodenal anastomosis. Luminal diameter was increased, and no abnormal findings were encountered during the postmortem abdominal exploration. The technical feasibility of performing a safe laparoscopic pyloroplasty in a dog model was demonstrated in this study.